Análise dos atendimentos e do fluxo de identificação de pacientes não identificados em um hospital público de ensino

Abstract

Unidentified patients are those who arrive at the emergency department (ED) without identification documents, making it impossible to confirm their identity before initial care, which often requires prompt action. This situation challenges healthcare provision due to the lack of health history, increasing the risk of adverse events and affecting the quality, safety, and efficiency of care. International studies on this population do not investigate in detail the sequence of procedures for identifying them within healthcare services, and no studies on this topic have been found in Brazil. Therefore, this study aimed to analyze the characteristics of care and the identification flow of unidentified patients in a public teaching hospital. This is a quantitative, descriptive, and retrospective study that analyzed 332 medical records of unidentified patients admitted between 2019 and 2022 in a public teaching ED in Belo Horizonte, Minas Gerais. Sociodemographic data, initial care, admission procedures, outcomes, and patient identification flow were collected. Descriptive statistical analysis of the data was performed, with absolute values and proportions calculated for categorical variables and measures of central tendency (median) and variability (minimum, maximum) for continuous variables. A 95% confidence interval and a p-value < 0.05 were adopted. The study found a predominance of male patients (81.63%), belonging to the mixed race category (75%), with a median age of 32 years. The majority resided in Belo Horizonte (72.22%) and had a fixed residence (61.66%). Admissions were more frequent on weekends (38.25%) and at night (29.52%), and more than half (50.60%) were attended by SAMU 192. Most patients were classified with an orange/very urgent clinical priority (69.94%), mainly due to physical aggression (39.76%) and falls (20.48%). The main treatment areas were the clinical/surgical emergency rooms (89.76%), and the initial evaluation was conducted by a general surgeon(84.04%). Regarding the XABCDE protocol, 6.56% had exsanguinating hemorrhage, 45.26% used a cervical collar, 93.71% had a patent airway, and 76.11% were breathing ambient air. Most patients had palpable peripheral pulses (80.78%) and 6.76% were admitted in cardiac arrest. The median Glasgow Coma Scale score was 14. All required medical interventions such as sutures (51.34%), computed tomography (59.94%), and peripheral venous access (78.92%). The median length of stay in the ED was one day, with the majority being discharged home (55.54%) and 8.02% dying in the ED. Among the admitted patients (161), 28.57% were discharged directly from the ED, 26.70% were admitted to the surgical unit, 19.87% to the intensive care unit, and 19.87% to the inpatient unit. Of the 86 patients hospitalized, the median length of stay was eight days, with 74.69% being discharged and 24.1% dying. Regarding the identification flow, most (70.8%) were discharged as 'unidentified'. Among those identified, 66.63% were identified by family members and 27.55% through self-declaration. The most frequent identification methods were presenting an identification document (64.76%) and selfidentification (27.55%). The main reasons for non-identification were self-declaration without a proof document (55.48%) and death (23.45%). Unidentified patients often present with trauma that has the potential for clinical severity upon admission, necessitating early interventions and critical care, making it crucial to invest in the identification process to ensure safe care. The low identification rate highlights the need to improve this process during care provision.